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Stories of grit & miracles
An elderly man got successful TAVI at AMRI Hospitals Bhubaneswar

An elderly man got successful TAVI at AMRI Hospitals Bhubaneswar

An 83-years-old man was admitted with recurrent fainting (loss of consciousness) and breathlessness. On evaluation he was found to have severe calcific aortic stenosis. The treating doctor, Dr. Dibya Ranjan Behera, Cardiologist, AMRI Hospitals Bhubaneswar said, “This is a heart disease where one of the valves, which connect the left ventricle with the aorta  was tightly stenosed. In simple words, the exit gate of the left side of  heart was almost blocked so that oxygenated blood was unable to go the major blood pipe at the speed which is required. When such patient do slightest exertion blood flow to the brain decreases and he will get fainting attack, which is sometimes deadly. Coronary arteries also got less blood flow and he will get chest pain (angina) and even heart attack. The blood in the lungs get stuck and causes breathlessness.”

This is one of the very fatal (deadly) diseases which should be immediately treated. The treatment is simply replacing the damaged aortic valve called "Aortic Valve Replacement (AVR)". This was usually  done by open heart surgery.

He also said, "But in many patients like very elderly, with other severe comorbidities open heart surgery is considered as high risk. Recently with the advancement of science, this procedure can be done by catheter intervention only, without need of open heart surgery. This is called Transcatheter Aortic Valve Implantation/Replacement ( TAVI/ TAVR).

“TAVI has revolutionized modern day cardiac intervention in terms of its usefulness and benefits in elderly high risk patients."

A cardiac team led by Dr. Behera  did  TAVI successfully using balloon expandable valve-  MyVal in this 83-years-old gentleman. Needless to say that he was discharged home within 2 to 3 days of the procedure. Now he was able to do all his works without any symptoms.

The patient and the patient family are very happy and expressed their gratitude to AMRI Hospitals management as well as the treating doctors Dr. Biswajit Mohapatra (CTVS surgeon), Dr. Vivek Chowdhury and Dr B. Rath, Cardiac anesthesiologists and entire Cathlab team, CCU team for this remarkable accomplishment.

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AMRI Doctors replaces Aortic valve with TAVR

A 78-year-old patient from Paradip, Odisha, underwent successful heart Aortic valve replacement with TAVR (Transcatheter Aortic Valve Replacement) without open- Heart surgery by a team of doctors led by Interventional Cardiologist and structural Heart Disease specialist, Dr J K Padhi, Director, Cardiology, AMRI hospitals Bhubaneswar.

The patient was suffering from Severe Aortic stenosis. Due to the above heart problems, he was finding difficulty in doing his Daily activities and would become short of breath on minimal exertion. The patient was advised Surgical Aortic valve replacement (SAVR). But due to high risk surgery was denied and patient was plan for onsurgical treatment doing TAVR.

He was also hospitalized for heart failure at his home town. Due to the severe narrowing of the Aortic valve, medicines were not working for his disease, and the only treatment offered was valve replacement. Dr Padhi replaced Aortic valve by performing TAVR, non-surgically at AMRI Hospitals Bhubaneswar.

“This transcatheter native Aortic valve replacement now performed worldwide and is the first case in AMRI Hospitals Bhubaneswar. This treatment has brought a new ray of hope for the patient and his family.” Said, Ms Nilanjana Mukherjee, Vice President & Unit Head, AMRI Hospitals Bhubaneswar.

“Aortic stenosis refers to the narrowing of the Aortic valve. Aortic valve is the outflow valve that controls the oxygenated blood flow from the heart to the body.

Narrowing of Aortic valve creates a life-threatening situation called Aortic stenosis and heart failure.”, said Dr. Sidharth Mishra, Medical Superintendent, AMRI Hospitals Bhubaneswar.

The patient was admitted to the hospital with the condition of heart failure, a history of shortness-of-breath, difficulty in walking, and carrying out daily activities.

Traditionally such patients are treated with open-heart surgery.

“Whether TAVR or SAVR is more appropriate for a given individual depends on multiple factors and is discussed with each patient by a heart team comprising of both an interventional cardiologist and a cardiac surgeon. Now-a-days, TAVR is mostly recommended in elderly frail individuals having previous history of heart surgery, brain stroke and comorbid systemic disease involving lungs, liver and kidney.

TAVR when compared to surgery is safer in selected patients.” Said, Dr. J K Padhi, Director, Cardiology, AMRI hospitals Bhubaneswar.

FAQ

What is TAVR?

Transcatheter Aortic Valve Replacement (TAVR) is a minimally invasive procedure to replace the Aortic Valve in patients with diseased Aortic valve. The development TAVR has emerged as a lifeline for patients considered to be inoperable by open heart surgery also called as surgical Aortic Valve Replacement (SAVR).

How to prepare for TAVR

The heart team will access the patient’s general condition through various imaging (TVAR CT protocol / Coronary angiography) and blood tests before TAVR surgery, to confirm the condition of the patient’s lungs and heart. The team will also advise a heart ultrasound to the patient to estimate aortic valve.

How TVR Works?

During TAVR, interventional cardiologist inserted a catheter through a small cut in the skin over the blood vessel in the groin to deliver and implant the artificial valve which anchors over the diseased valve. TAVR procedure typically takes less than one hour and usually done under mild sedation or general anaesthesia.

Recommendations post TAVR recovery

After the procedure, the patient will be transferred to the intensive care unit (ICU), so as to closely monitor the patient for any redness, swelling or bleeding from the groin site. They are prescribed blood thinners during discharge. Most patients go home the next day and are allowed to resume their normal activities.

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Heart attack patient’s life saved with Penumbra device

A 53 year old gentleman who was suffering from acute chest pain for about four hours came to AMRI Dhakuria’s Emergency in the midnight.
The ECG showed a massive heart attack. The patient was immediately admitted for a Primary Angioplasty, when an Angiogram revealed a huge blood clot in the arteries of the heart.
The clot was very efficiently removed with the help of Penumbra thrombosuction and the blood flow was restored followed by placing a stent. A precious life was saved in the most rapid process.
The super hero of this rescue operation was Penumbra Device. It is a latest generation instrument to address the challenging medical conditions related to huge clots in the arteries.Penumbra thrombectomy device is a specialized mechanical thrombus aspiration system which consists of a motorized pump and a special type catheter. This system works very effectively in cases of large thrombus (clot) because the specialized catheter disintegrates large
chunk of thrombus into small parts and the mechanical pump aspirates the clot. Generally it is used in large arteries like brain or arteries of legs or in pulmonary arteries. It is not commonly used in coronary arteries,
because CAT catheter may cause damage when rotating in a small sized coronary artery. But with a modified technique our cardiology experts connected normal thrombo aspiration catheter with Penumbra mechanical pump. This leads to outstanding results as the thrombo suction flow improves significantly and the stent insertion becomes
smooth and faster. This technique gave outstanding end result in previous cases too. Cudos to our Cardiology team.

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In a rare occurrence, a 61-year-old patient suffered an acute subdural haematoma or bleeding in the brain two days after being detected with dengue

Kolkata, 02.11.2022: In a rare occurrence, a 61-year-old patient suffered an acute subdural haematoma or bleeding in the brain two days after being detected with dengue. Doctors believe that while they have read about cases of dengue-induced cerebral haemorrhage in medical textbooks, none of them have ever come across such a case in recent times.

Tapan Biswas, a resident of Shahidnagar in South Kolkata, visited the OPD of AMRI Hospital Dhakuria on 27th September, 2022 with high grade fever, and was admitted after he tested positive for dengue. Dr Mahuya Bhattacharjee, Senior Consultant, Internal Medicine & Critical Care, the supervising physician of Mr BIswas, said, “When Mr Biswas had come to the OPD on 27th September, he came walking by himself and had no neurological complaints.”

Although Mr Biswas was otherwise stable, from 29th September afternoon he started complaining of severe headache, suddenly lost consciousness, and slipped into coma. “He was put on ventilator and a CT scan revealed that Mr Biswas had suffered an acute subdural haematoma, which was definitely triggered by dengue,” said Dr Bhattacharjee, who had treated Dr Biswas for COVID-19 during the Delta wave. She, however, was clear that COVID-19 did not have any role to play in his recent complications.

Consultant Neurosurgeon, Dr Nirup Dutta, who lead the surgery team, said, “There was a sizeable blood clot between his brain and skull, which was putting immense pressure on the brain. We operated on him that same night and after a two-hour-long surgery managed to clear the area of any clots. We cut out a piece of the skull and put it in an abdominal pocket so that it stayed healthy and we can put it back later. We conducted the surgery while he was still in coma and he was put back on ventilator.”

Dr Dutta explained that the severity of a coma is measured by the Glasgow Coma Scale on a range of 3 to 15, with 3 being the worst and 15 being the best condition. “Mr Biswas measure 4 on the coma scale but we managed to revive him. After the surgery, he was on ventilator for seven days, after which he was extubated and discharged on 10th October,” he said. Dr Bhattacharjee pointed out that when Mr Biswas visited for his first review on 1st November, he was able to walk by himself and there are no neurological deficits

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Here is a success story from NICU of AMRI Hospitals Bhubaneswar. 

700-grams premature baby born at 25 weeks(6month) got a new life at AMRI Hospitals Bhubaneswar  

AMRI Hospitals Bhubaneswar’s NICU team saved an 700-gram premature baby with multiple problems and issues. Here's how the medical staff at AMRI Hospitals Bhubaneswar saved the newborn baby's life.  

A woman from Puri, Odisha delivered girl child at just 25 weeks of her pregnancy in the month of June.  

After the conceiving  baby, the Parents were doing their regular check ups with Dr Monica Gupta, Gynecolgy, AMRI Hospitals. When the premature delivery happened, the desperate parents, with an aim of saving the surviving neonate, approached the department of Paediatric & Neonatology, AMRI Hopspitals.  

The baby received a thorough treatment and care under the care of Dr. Janaki Ballav Pradhan, Dr. Monica Gupta and the NICU Team of AMRI Hospitals Bhubaneswar. "The baby was extremely small and she had all the complications of prematurity. There were many continuous challenges during the treatment. The baby received 3 doses of surfactant, on ventilator support for 1 month and treatment for closure of patent ductus arteriosus. After that when she developed pneumonia and sepsis, we almost lost hope, but the baby was a fighter. With the efforts of all our nurses and doctors, we were able to overcome those issues. She is now healthy and neurologically normal. We are incredibly happy that we were able to save her life and send her home happily with her parents," said Dr Janaki Ballav Pradhan & Dr Monica Gupta who were the treating Doctors of the baby.  

"Extreme prematurity with less than 26 weeks especially with birth weight of 700-grams or less rarely survive without any neurological sequalae. Only a few case reports of this kind are found internationally. After a long wait and a lot of complications ventilator dependency, many blood transfusions  baby's general condition improved. After 102 days, the mother is feeding the baby directly and the baby discharged from the hospital with  weight of 2kg with normal neurological activities with normal hearing and eye condition” Said, Dr Janaki Ballav Pradhan. 

Treating Doctors:

Dr Janaki Ballav Pradhan , MBBS, MD (Paediatrics) , DM (Neonatology), FIAP, Consultant, Neonatology & Paediatrics

Dr. Monica Gupta, MD (AIIMS, Delhi), DM Reproductive Medicine & Surgery (AIIMS, Delhi), MRCOG (London, UK), Ex Consultant AIIMS , Delhi, Senior Consultant O&G - AMRI Hospitals, Bhubaneswar 

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Mesh & Glue tape Patient: Sheikh Salim

Mesh & Glue is the latest technology where sutures are not needed for surgeries and there is hardly any scar. The technology as used for the first time in Eastern India on a patient of TKR, where instead of stitching or stapling, the Mesh & Glue tape was used like a Band-Aid. The mesh was put on the knee that has undergone surgery, and glue was applied on the layer, using a glue pen that has a brush attached to it. The glue dries up within a few minutes and a bandage dressing is used as an extra layer of precaution. Mesh & Glue is disposable, with there being no need for the patient to return to the hospital for dressing or cutting of stitches, and they can peel it off like a Band-Aid even at home.  

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Oxynium Black Knee Implant Patient: Namita Saha

A state-of-the-art knee replacement implant built from oxynium, which is much more resilient, was done for the first time in Kolkata. Oxynium is a derivative of titanium, with a special coating that is black in colour, giving the implant its name. Unlike knee implants made of cobalt chrome, which last around 15 years and need to be replaced, oxynium knee replacements can survive without any hassles for around 35 years. It is much better for younger people, there is no debris like is noticed in ceramic implants, and the lubricating surface is much better, causing minimal abrasion.  

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Kolkata: Doctors save hand of software engineer who sustained severe cut from electric saw

KOLKATA: Fifty-year-old software engineer Manajit Kar had sustained severe hand injury on July 17 while using an electric saw. When the Jadavpur resident reached AMRI Hospital, Dhakuria, last Sunday he had lost a significant amount of blood. He was in shock, his blood pressure had dropped drastically, and his sensorium was compromised. Sight of the injury on his left arm shocked even the most seasoned hospital staff.

His brother, scientist Abhijit Kar, who accompanied him, said that the patient was cleaning his garden with an electric saw at the terrace garden of their family home on Sunday evening. "It was drizzling and he slipped, accidentally slicing off a major part of his left arm. We somehow managed to cover the wounded arm with towels and rushed him to hospital."

Dr Anirban Ghosh, Consultant reconstructive surgeon of AMRI Hospitals, pointed out that Kar's injury was severe, with the nerves, veins, arteries, tendons and muscles were all critically damaged.

"We could feel no pulse due to nature of his injury and his arm had gone cold as there was no blood circulation. He came around 7 PM and we started the surgery to restore his arm by 9 PM. The surgery went on till 1:30 AM and we were able to revive his arm," he said.

During the course of the surgery, Dr Ghosh and his team repaired the arteries, nerves, tendons, and muscles, besides reconstructing the skin and re-establishing blood circulation in his damaged arm. "We took some veins from his legs to reconstruct the veins, which were badly injured. The arm became warm soon after the surgery. However, given the extent of his injuries, it will take at least six months for full sensation to return to his left arm," Dr Ghosh said.

The reconstructive surgeon added that while the damage to his nerves was severe, since cells in the nerves grow at a rate of 1 millimetre per day, his arm will feel stronger over a period of time.

"Lam indebted to Dr Ghosh for saving my arm. He has advised me to change the dressing on regular intervals. He has also assured me that over a period of time, I will have full sensation in my arm," said Kar who was discharged from the hospital on Friday.

"When we arrived at the hospital we had almost no hope. We were scared that he would not only lose his limb, but maybe even his life. We are happy and relieved that he is doing much better and he will be able to use his left arm properly within some time." wife Anindita said.

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